& Continuing Education Courses
Sponsored by: Jordan Hearing and Balance, LLC South Jordan Utah
Lynn S. Alvord PhD
Rehabilitation of Dizziness, Balance, or Falling
Vestibular rehabilitation differs from the general “gait and balance rehabilitation” performed by physical therapists which can include vestibular rehabilitation but often does not, focusing instead on musculoskeletal or central nervous system balance problems. Therapists for vestibular rehabilitation, whether PT, OT or audiologists, need special training in this area which usually involves additional course work beyond the regular coursework received during their training. Vestibular rehabilitation includes maneuvers for BPPV, but is certainly not limited to this. Patients with vestibular disorders such as vestibular neuritis, acoustic neuroma (before, after or instead of surgery), etc., usually have a “weak ear” for the balance function on one side. Because the weak ear is giving wrong information to the nervous system, the exercises are aimed at teaching the nervous system to focus more on the ear that is giving correct information, as well as coordinate the ear input with the eye and muscular inputs. Other mechanisms possibly at work are neural adaptation/habituation, where the nervous system is “getting used to” the feelings of vertigo, somewhat like an ice skater learning to spin and not feel dizzy. In addition, “substitution” may occur, where the other balance systems (somatosensory and visual) largely take over the function of the weak inner ear system. Hopefully, this latter method is used only in cases where the inner ear balance function is not fully recoverable. Vestibular rehabilitation has been shown by research to hasten recovery from the vertigo or imbalance associated with inner ear disorders.
The prognosis for full recovery varies with the severity of the disorder, and whether or not some permanent damage has occurred to the vestibular system. Also of importance to prognosis is the status of the patient’s general health, particularly the status of the lower extremities, visual system and medications that might suppress the nervous system, any of which can slow or impede full recovery.